System and method for providing optimal concentrations for medication infusions

ABSTRACT

Optimum concentrations for a drug administered as a medical infusion to a patient, particularly a pediatric patient, are determined. The determination is made using inputs regarding (1) the drug to be administered; (2) the patient; and (3) the infusion process. The optimum concentrations are displayed to a user, such as any health care provider. A chart illustrating the distributions of concentrations over a range of doses and patient weights is also provided.

The present application claims the benefit of U.S. ProvisionalApplication No. 60/556,075, filed on Mar. 25, 2004, which is herebyincorporated by reference in its entirety.

BACKGROUND

1. Field of the Invention

The present invention relates generally to providing optimalconcentrations for drugs to be administered as medical infusions. Moreparticularly, the present invention relates to providing two to fouroptimal concentrations for drugs administered as continuous infusionsfor compliance with JCAHO standards.

2. Background of the Invention

A recent mandate by the Joint Commission on Accreditation of Hospitals(“JCAHO”) requires all pediatric hospitals to alter the manner in whichthey administer continuous medication infusions to critically illinfants and children. The mandate requires that hospitals choose fromamong only a few standard concentrations for drugs administered ascontinuous infusions for all pediatric infusions. Prior to the JCAHOmandate, infusion concentrations were calculated on the basis of apatient's weight. Due to weight variations between patients, eachpatient likely was assigned a different concentration. As a result, therange of potential concentrations was essentially limitless. The JCAHOmandate forces hospitals to limit this once unlimited range to only afew standard concentrations.

A problem that arises from the JCAHO mandate is that pediatric hospitalsare unsure how best to determine these three concentrations. In anattempt to overcome this problem, many hospital pharmacists and medicaldirectors are posting questions on email lists to determine what otherhospitals have done to identify the two to four optimum concentrations.Some of the hospitals have developed their own list of threeconcentrations. Such individually determined concentrations generallyvary from hospital to hospital, thereby defeating the very purpose ofstandardization as mandated by the JCAHO. Conventional techniques fordetermining the two to four optimum concentrations for about 40 commonlyused drugs are tedious, time consuming, trial-and-error approaches thattypically require input from physicians, nurses and pharmacists.

BRIEF SUMMARY OF THE INVENTION

When ordering a continuous drug infusion for a pediatric patient, it iscrucial to select optimum drug concentration based on patient weight anddose. The resulting infusion rate (mL/hr) should be such that it isneither too low, resulting in imprecise drug delivery, nor too high,resulting in fluid overload. Embodiments of the present invention ensurethat the infusion rate will not fall below the lowest acceptable rateindicated by the user. Based on the lowest acceptable rate, successivelyhigher concentrations for larger patients or patients who require higherdoses are determined to ensure sufficient drug concentration whileavoiding excessive fluid load. According to embodiments of the presentinvention, the resulting fluid load is always less than 8% of the dailyfluid allowance. Thus, embodiments of the present invention perform adual function of first identifying optimum drug concentration (forexample, optimum 2 to 4 ideal concentrations) for each drug, and thenrecommending one of these concentrations for each specific patient anddrug-dose combination.

Based upon several inputs regarding the type of drug used, the weight ofthe patient, and the infusion process, embodiments of the presentinvention provide the two to four optimum concentrations for a drug tobe administered as a continuous infusion. Moreover, embodiments of thepresent invention display how these three concentrations will suit theentire range of patient sizes in pediatrics (from the smallest prematureinfant to a large adolescent) as well as across the entire useable doserange. The time to determine these concentrations according toembodiments of the present invention typically is less than one minute.Reviewing the results of the program and ascertaining that theconcentrations selected by the program are appropriate typicallyrequires another five minutes or so. Thus, embodiments of the presentinvention help determine concentrations for all 40 drugs within 3 to 4hours. Conventional techniques, on the other hand, typically requireweeks or even longer to determine these concentrations.

Beyond significantly reducing the time required for individual hospitalsto determine optimal drug infusion concentrations, another advantageprovided by embodiments of the present invention is that it enablesmultiple hospitals to act in a collaborative manner to determine the twoto four optimum concentrations. Thus, instead of each hospitaldetermining its own optimum standard concentrations. Such collaborationcan lead to consensus, for example, on a national level thereby trulystandardizing the process and enhancing patient safety.

Other benefits of the present invention include:

-   -   1. Assisting identification of the optimum concentration to the        ordering physician from a choice of two to four possible        concentrations. This identification takes into account patient        weight and dose and, based on these parameters, suggests the        best choice;    -   2. Providing a dose-weight-infusion rate chart that can be used        by nurses to correctly infuse the medications thereby avoiding        medication errors; and    -   3. Providing pharmacists with precise instructions on how to        compound medications, thereby reducing chances of compounding        errors.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a flow chart for a method for providing optimal concentrationsfor drugs administered as medical infusions according to an embodimentof the present invention.

FIG. 2 is an exemplary format for obtaining input data according to anembodiment of the present invention.

FIG. 3 is an exemplary output showing four determined concentrations andother information corresponding to the input illustrated in FIG. 2.

FIG. 4 is an exemplary table of calculated infusion rates at differentdoses output by an embodiment of the present invention.

FIG. 5 is an exemplary table of percentage of maintenance correspondingto the infusion rate data shown in FIG. 4.

FIG. 6 is an exemplary order sheet according to embodiments of thepresent invention.

FIG. 7 is a flow chart illustrating an aspect of embodiments of thepresent invention for assisting physician order entry.

FIG. 8 is an exemplary form that can be displayed to a user for enteringa drip order according to an embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments of the present invention assist medical practitioners indetermining a plurality of optimum concentrations for drugs to beadministered as continuous infusions in pediatric patients, such ascritically ill infants and children. For example, in a preferredembodiment of the present invention, three optimum concentrations (low,intermediate and high) are provided. A drug to be administered as amedical infusion is predetermined for administration to the patient.

In one embodiment, the present invention is a computer program executingon a personal computer. Typically such computes include amicroprocessor, internal memory, external mass storage (including, forexample, disk or CD-ROM) and communication bus structure. In addition,such computers typically include an entry device such as a keyboard, apointing device such as a mouse, output devices such as a display screenand a printer. Such personal computers are well-known in the art andneed not be described further.

Using data input by a user, ideal concentrations that suit the needs ofan entire range of pediatric patients are determined and displayed tothe user. In a preferred embodiment of the present invention, this rangeextends from the smallest premature infant (approximately half a poundin weight) to a large adolescent patient (as much as 200 pounds inweight), and across all dose ranges (from minimum to maximum dose). Inaddition to determining the ideal drug concentrations, embodiments ofthe present invention allow users to select the optimal concentrationtailored to the needs of the individual patient. In addition, thisinformation may be displayed in a table with automatic programmedcolor-coding to enable users to visually identify the optimumconcentration for a patient of a certain weight and/or requiring acertain dose range. Alternative concentration indicators such as grayscaling or cross hatching can be used.

FIG. 1 is a flow chart 100 for a method for providing optimalconcentrations for drugs administered as medical infusions according toan embodiment of the present invention. In steps 102, 104 and 106 inputdata is entered, for example, by a user. This input data includes dataabout the drug to be administered, the patient and the infusion process.The drug input data can typically be found in standard drug referencetexts that are well-known to those skilled in the art. In an embodimentof the present invention, the drug input data is stored in a databaseaccessible to the personal computer on which a computer programembodiment of the present invention executes. The database includesinformation describing each drug considered by an embodiment of thepresent invention. According to one embodiment of the present invention,the database includes the following information describing each drug:

-   -   (1) drug name;    -   (2) minimum dose;    -   (3) maximum dose;    -   (4) dose increment interval;    -   (5) dose units;    -   (6) low concentration;    -   (7) intermediate concentration;    -   (8) high concentration;    -   (9) maximum concentration;    -   (10) maximum peripheral and central concentrations permitted;    -   (11) commercially available premixed concentrations;    -   (12) commercially available premixed concentrations stocked        locally;    -   (13) concentration of drug in vials;    -   (14) vial concentrations stocked daily;    -   (15) reference text source;    -   (16) rule of six concentration;    -   (17) rounding factor;    -   (18) multiplication factor;    -   (19) lowest patient weight in whom drug is used;    -   (20) lowest acceptable infusion rate;    -   (21) whether drug used as bolus;    -   (22) drug included in Pediatric Advanced Life Support Manual;    -   (23) drug stocked locally in cardiac arrest cart;    -   (24) drug used to treat arrhythmias;    -   (25) drug used in transport;    -   (26) concentration used in cardiac arrest situation;    -   (27) pharmacy mnemonic;    -   (28) volume of drug infusion used;    -   (29) volume of commercially available premixed drugs;    -   (30) diluent used for dip;    -   (31) generic name of drug;    -   (32) replace trade name with generic name;    -   (33) drug specific help information;    -   (34) therapeutic category;    -   (35) need for mechanical ventilation;    -   (36) drug dosage intervals;    -   (37) maximum drug amount to be dispensed at one time;    -   (38) adult dosing formula if applicable; and    -   (39) recommended concentration based on weight category.

Such drug input data includes minimum and maximum dose and incrementinterval. Patient data includes data such as the patient's weight andfluid requirements. Infusion data includes data about the infusionprocess such as the acceptable infusion rate.

FIG. 2 is an exemplary data input format for obtaining the requiredinput data from a user. As shown in FIG. 2, inputs according to anexemplary embodiment of the present invention include:

-   -   (1) minimum dose;    -   (2) maximum dose;    -   (3) dose increment;    -   (4) lowest patient weight (in whom the medication will be used);    -   (5) lowest acceptable infusion rate (minimum pump rate); and    -   (6) total fluid intake goal (fluid limit).        In addition, two other inputs are used in the exemplary        embodiment of the present invention. These are:    -   (7) maximum allowable fluid load resulting from infusion of one        medication; and    -   (8) maximum permitted concentration for each medication.

In step 108, the input data is processed to determine the two to fouroptimum concentrations (low, intermediate, high and super high). In oneembodiment of the present invention, the lowest concentration is the onethat results in the lowest acceptable infusion rate at the lowest dosefor the lowest weight patient and the highest concentration ispredetermined based on published pharmacological data. In such anembodiment of the present invention, the intermediate concentration isthen determined based on the range between the minimum and maximum dose.Moreover, embodiments of the present invention can default tocommercially available premixed concentrations whenever such premixedconcentrations are available.

For example, according to one computer-based embodiment of the presentinvention, the computer program processes the data as follows:

-   -   1. Low concentration is determined by the computer program as        follows:        -   a) First, the drug information sheet built into the program            to see if only one concentration is permitted for a            particular drug. The drug information sheet contains            information related to various drugs. The information can be            found in standard drug texts that are well-known to those            skilled in the art. If the answer is yes, then the Final Low            Concentration equal to the only permitted concentration is            displayed.        -   b) Next, the Preliminary Low Concentration using the            following formula is calculated:            -   Preliminary low concentration=Lowest patient weight                multiplied by Lowest dose divided by lowest pump                infusion rate.        -   c) Next, the Preliminary Low Concentration is compared to            the maximum permitted concentration. If the Preliminary Low            Concentration is greater, the algorithm displays the Final            Low Concentration value equal to half the value of the            maximum concentration.        -   d) The drug information sheet is then checked to see if            there is a commercially available premixed concentration and            if so, whether the available premixed concentration is less            than the calculated Preliminary Low concentration. If it is            less, then the Premix concentration is displayed as the            Final Low concentration. If it is not less, then the            Preliminary Low Concentration is displayed as the Final Low            Concentration.    -   2. The Intermediate Concentration is determined by the computer        program as follows:        -   a) The ratio of maximum to the minimum dose range is            calculated. If the calculated ratio is greater than 20, 4            times the value of the Low Concentration is displayed as the            Intermediate Concentration. If the calculated ratio is less            than 20, 2 times the value of the Low concentration is            displayed as the Intermediate Concentration.        -   b) Then, the Intermediate Concentration calculated in 2(a)            is compared to the Maximum permitted concentration. If the            Intermediate Concentration is greater, the value of Maximum            Concentration divided by two is calculated. If the result of            the calculation is greater than the Low Concentration            calculated in 2(a), the result of the calculation is            displayed as the Intermediate Concentration.    -   3. The High Concentration is determined by the program algorithm        as follows        -   a) If the ratio of maximum dose to minimum dose is greater            than 20, then the High Concentration is calculated as four            times the Intermediate Concentration. If the ratio is            greater than 10 but less than 20, the High Concentration is            calculated as three times the Low Concentration. If the            ratio is less than 10, then the High Concentration is            calculated as two times the intermediate concentration.

The outputs of processing step 108 are illustrated in steps 110, 112 and114. The output illustrated by step 110 is the two to fourconcentrations. The output illustrated by step 112 is the fluid loadresulting from each of the two to four concentrations. The outputillustrated by step 114 is the minimal incremental does for each of thefour concentrations. FIG. 3 is an exemplary output showing fourdetermined concentrations and other information corresponding to theinput illustrated in FIG. 2.

In step 116, the availability of commercially premixed concentrations ofa particular drug is determined. This information can be stored, forexample, in the drug information sheet described above. If such premixconcentrations are available, then in step 118, it is determined whetherthe commercially available concentration falls close to one of the Low,Intermediate or High Concentration. If they do fall close, then in step120, the one or more of these concentrations falling close is replacedwith the closest commercially available premixed concentration.

In step 122, it is determined whether the fluid load is within a goal,i.e., within a desired clinical range. If the fluid load is not withinthe goal, then in step 124 the optimal concentration out of a choice ofthe 2 to 4 that were determined is selected in order to bring the fluidload within the desired clinical range. The selected concentration isthen displayed in step 126.

In step 128, it is determined whether the minimal possible incrementaldose is outside acceptable limits. In step 130, the amount of drugdelivered at the lowest infusion rate of 0.1 milliliter per hour iscalculated. If the amount of drug at this infusion rate is greater thantwo times the increment interval, the program alerts the user in step132.

In step 109, a table showing calculated infusion rates at differentdoses and different weights is displayed. In an embodiment of thepresent invention, the infusion rates are programmatically color-codedto identify the correct selection of concentration for any given weightand dose in order that the resulting fluid load is within the clinicallydesired range. In alternate embodiments of the present invention, theinfusion rates are distinguished using gray scaling or cross hatching.FIG. 4 is an exemplary table of calculated infusion rates at differentdoses output by an embodiment of the present invention. Concentrationboundaries are illustrated by sections 402 (low), 404 (intermediate),406 (high), 408 (maximum) and 410 (exceeded maximum) respectively.

The table can also be output to show the percentage of maintenancecorresponding to the calculated infusion rates at different doses. FIG.5 is an exemplary table of percentage of maintenance corresponding tothe infusion rate data shown in FIG. 4. In FIG. 5, concentrationboundaries are illustrated by sections 502 (low), 504 (intermediate),506 (high), 508 (maximum) and 510 (exceeded maximum) respectively.

FIG. 7 is a flow chart illustrating an aspect of embodiments of thepresent invention for assisting physician order entry. In step 702 auser, for example a health care provider, such as a physician and/or anurse, enters patient data. The patient data can include demographicdata such as name, MR number and patient weight. In addition to thepatient data, ordering physician data is entered. The ordering physiciandata can include data such as ordering physician name and pager number.In addition, patient fluid goal is selected. The patient fluid goal canbe in units of mL/kg/day or “times maintenance”.

In step 704, the user selects a medication. For example, the medicationor drug can be selected by name. According to one embodiment of thepresent invention, upon selecting the medication, a drug informationhelp box is displayed to the user. The drug information help boxdisplays additional drug information to assist the user in correct drugusage. Such information can include safety alerts, drug usageguidelines, alerts and warnings.

In step 706, the user selects drug dose. To assist the user in selectingan appropriate dosage, embodiments of the present invention display theusual dosage range to the user. In step 708, a safety check isperformed. For example, as a safety measure against overdose,embodiments of the present invention display a warning to the user ifthe user selects a dose greater than the usual range. Embodiments of thepresent invention further require the user to obtain a second physiciansignature to confirm unusually high doses. Further, as a safety measureagainst excessive dosage, embodiments of the present invention, inaddition to displaying an alert, prevent ordering of doses greater than2 times the upper limit of the usual dosage range.

After an appropriate dose is selected, in step 710, the optimumconcentration for the medical infusion is determined such that the fluidload resulting from the selected concentration is always within theacceptable fluid load selected by the user. The optimum concentration isdetermined as described above.

In step 712, the optimum concentrations determined in step 710 can bemodified manually by the user if desired. For example, the user maymodify the optimum concentrations determine in step 710 to accommodatevarying clinical needs of each patient. In addition to modifying theoptimum concentration, if desired, the user can add special comments(e.g., nursing instructions) for each drug.

In step 714, the fluid load in mL/hour and percentage maintenance foreach drip is displayed to the user. In addition, the total fluid load inmL/hour and percentage of maintenance is displayed for all drugs.

After drugs and doses are selected, a user can print out the orders foreach drug. Prior to printing out the order, however, in step 716,embodiments of the present invention provide a confirmation display tothe user. The confirmation screen requires the user to verify inputparameters as a safety measure prior to printing out the order. Theinput parameters requiring confirmation can be any of the inputparameters to provide the required level of safety, including forexample, patient identity, patient weight, names of drugs selected anddoses for each drug.

After drugs and doses are selected, the user prints the final order thatis sent to the pharmacy and included in the patient's chart. FIG. 6illustrates an exemplary order sheet 600 according to an embodiment ofthe present invention. As shown in FIG. 6, exemplary order sheet 600includes a basic order section 602. Basic order section 602. includesthe name of the drug or medication, the dose, the concentration and theinfusion rate, e.g., in mL/hr.

Exemplary order sheet also include a pharmacy compounding instructionssection 604. Compounding instructions section 604 comprises a uniquepharmacy mnemonic for each drug order generated on the printout as wellas the volume of drug to be compounded. For example, the mnemonic forDopamine, 250 ml infusion volumes is “DOPA2.” Entering the uniquemnemonic in the pharmacy computer system brings up the correctcompounding instructions for the pharmacist. Compounding instructionssection 604 also includes the total amount of medication required interms of total volume. Compounding instructions section 604 also alertsthe pharmacy to the availability of commercially available premixed drugconcentrations. When such premixed concentrations are available, thepharmacy can use them, thereby eliminating the need for the pharmacy tocompound such orders. Compounding instructions section 604 furtherincludes the final concentration, e.g., in mcg/mL.

Exemplary order sheet 600 further includes a nursing instructionssection 606. Nursing instructions 606 provides instructions on how toprogram the infusion pump to correctly infuse the drug at the desireddosage. Embodiments of the present invention use a standard mathematicalformula (which varies depending upon the drug used) to double check andconfirm drug dosage calculations.

Exemplary order sheet 600 further includes a dose change instructionssection 608. In dose change instructions section 608, any dose changeorders are entered by physicians.

Exemplary order sheet 600 further includes a drip table 610. Drip table610 is a dosing table that displays a grid of the entire range of dosesand the corresponding infusing rate in mL/hr. Drip table 610 provides aneasy reference to ensure the correct infusing rate for any dose range.

Embodiments of the present invention also incorporate safety features,some of which have been described above. For example, embodiments of thepresent invention can incorporate one or more of the following safetyfeatures:

(1) All fields must be entered—A user cannot proceed if any field isincomplete. This requirement ensures that critical safety data such aspatient weight, patient identification and name of the orderingphysician are not inadvertently omitted.

(2) Drug reference information is displayed whenever a drug is selected.This feature provides useful information and safety alerts to theordering physician at the point of ordering.

(3) Safety against excessive dosage—As described above, embodiments ofthe present invention can alert the user if the user selects a dose thatis greater than the usual range and require the user to confirm the doseby a second physician. If the selected dose is greater than 2 times theupper limit of the usual dose range, embodiments of the presentinvention can prevent the user from proceeding with the order. A factorother than 2 can be used in embodiments of the present invention. Itwould be apparent to those skilled in the art that additional safetyfeatures could be added if desired.

(4) Drugs using a continuous infusion require multiple calculationsteps. Embodiments of the present invention, as described above, performall required calculations thus eliminating errors often introducedduring manual calculations.

(5) All orders are in the form of a computer-generated printout, therebyeliminating errors resulting from illegible handwriting.

(6) The order sheet printout output by embodiments of the presentinvention provides comprehensive, step-by-step instructions to thepharmacist for compounding each drug infusion and to the nurse forcorrect infusion of each drug. This feature minimizes errors resultingfrom incorrect compounding and incorrect infusion of the drug.

(7) The order sheet printout provides a dosing table showing infusionrates at all dose ranges. This feature provides the nurse with a quickreference to ensure that the dose ordered is being infused at thecorrect infusion rate.

FIG. 8 is an exemplary form 800 that can be displayed to a user forentering a drip order according to an embodiment of the presentinvention. For example, form 800 is an exemplary screen shot that can bedisplayed on display associated with a computer on which embodiments ofthe present invention execute.

According to an embodiment of the present invention, form 800 includes asection 802 for entering patient data. The patient data can include datasuch as patient name, patient weight, total fluid limit per day for thepatient, medical record number associated with the patient, name of theordering physician, and contact information for the ordering physician.

Form 800 further includes a section 804 for selecting the drug to beadministered and its dose. Entries in section 804 include drug name anddose as well as desired concentration changes and associated comments.Section 804 also provides a reference dose range to assist the user.Section 804 also displays fluid load based on the user's inputs.

Form 800 also includes an administrative section 806. Administrativesection 806 includes options for printing the drip order, clearing allentries, clearing drips and displaying an exemplary drip order.

The present invention also includes drugs made in accordance with any ofthe methods described herein. Such drugs include, for example, drugsmade in accordance with the optimum concentrations determined by thetechniques described above and/or using the system described above.

The foregoing disclosure of the preferred embodiments of the presentinvention has been presented for purposes of illustration anddescription. It is not intended to be exhaustive or to limit theinvention to the precise forms disclosed. Many variations andmodifications of the embodiments described herein will be apparent toone of ordinary skill in the art in light of the above disclosure. Thescope of the invention is to be defined only by the claims appendedhereto, and by their equivalents.

Further, in describing representative embodiments of the presentinvention, the specification may have presented the method and/orprocess of the present invention as a particular sequence of steps.However, to the extent that the method or process does not rely on theparticular order of steps set forth herein, the method or process shouldnot be limited to the particular sequence of steps described. As one ofordinary skill in the art would appreciate, other sequences of steps maybe possible. Therefore, the particular order of the steps set forth inthe specification should not be construed as limitations on the claims.In addition, the claims directed to the method and/or process of thepresent invention should not be limited to the performance of theirsteps in the order written, and one skilled in the art can readilyappreciate that the sequences may be varied and still remain within thespirit and scope of the present invention.

1. A method for determining one or more concentrations of a drugadministered as a medical infusion to a patient, comprising: obtaininginputs related to the drug to be administered as a medical infusion, thepatient, a fluid load goal, and an infusion process; determining the oneor more concentrations of the drug; and outputting one or moreconcentrations of the drug.
 2. The method recited in claim 1, furthercomprising: storing drug related information in a drug informationsheet; and using the stored information in determining theconcentrations.
 3. The method recited in claim 1, comprising:determining if there is only one concentration permitted for aparticular drug; and setting a concentration equal to the oneconcentration if only one concentration is permitted.
 4. The methodrecited in claim 1, comprising determining a low concentration, anintermediate and a high concentration.
 5. The method recited in claim 4,comprising: determining a preliminary low concentration equal to alowest patient weight multiplied by a lowest dose divided by a lowestpump infusion rate; comparing the preliminary low concentration to amaximum permitted concentration; setting the low concentration equal tohalf the value of the maximum permitted concentration is the preliminarylow concentration is greater than the maximum permitted concentration;determining whether there is a commercially available premixedconcentration; setting the low concentration equal to the premixconcentration if there is a premix concentration and the preliminary lowconcentration is less than the value of the premix concentration; andsetting the low concentration equal to the preliminary concentration ifthere is no premix concentration or the preliminary low concentration isnot less than the value of the premix concentration.
 6. The methodrecited in claim 1, comprising: calculating a ratio of a maximum dosagerange to a minimum dosage; setting the intermediate concentration as a 4times the value of the final low concentration if the ratio is greaterthan 20; and setting the intermediate concentration as 2 times the valueof the final low concentration is the ratio is less than
 20. 7. Themethod recited in claim 6, comprising: comparing the intermediateconcentration to a maximum permitted concentration; calculating a resultof dividing the maximum permitted concentration by 2 if the intermediateconcentration is greater than the maximum permitted concentration;setting the intermediate concentration to the result if the result isgreater than the intermediate concentration.
 8. The method recited inclaim 5, comprising: calculating a ratio of a maximum dose to a minimumdose; setting the high concentration to four times the intermediateconcentration if the ratio is greater than 20; setting the highconcentration to 3 times the intermediate concentration if the ratio isgreater than 10 but less than 20; and setting the high concentration as2 times the intermediate concentration if the ratio is less than
 10. 9.The method recited in claim 1, comprising calculating two to fourconcentrations.
 10. The method recited in claim 1, wherein the inputsrelated to the drug to be administered include one or more of drug name,minimum dose, maximum dose, dose increment interval, low concentration,intermediate concentration, high concentration, maximum concentration,commercially available premixed concentrations, whether commerciallyavailable premixed concentrations are stocked locally, rule of sixconcentration, lowest patient weight, and lowest acceptable infusionrate.
 11. The method recited in claim 1, wherein the inputs related tothe medical infusion include an acceptable infusion rate.
 12. The methodrecited in claim 1, wherein the inputs related to the patient includeone or more of patient weight and patient fluid requirements.
 13. Themethod recited in claim 1, comprising alerting user if an infusion rategreater than a predetermined value.
 14. The method recited in claim 1,comprising: calculating infusion rates using the determinedconcentrations; and generating a table containing the calculatedinfusion rates.
 15. The method recited in claim 14, comprisingcolor-coding the table to identify a correct selection of concentrationfor a given patient weight and dose so that a resulting fluid load inwithin a clinically acceptable range.
 16. The method of claim 1, whereinthe patient is a pediatric patient.
 17. A system for determining one ormore concentrations of a drug administered as medical infusion to apatient, comprising: a computer having a keyboard for enteringinformation related to the drug, the patient and an infusion process; aprocess executing on the computer for determining the one or moreconcentrations of the drug; and a display for displaying the determinedone or more concentrations to a user.
 18. The system recited in claim17, further comprising: a memory; and a drug information sheetcontaining drug-related information stored in the memory that is used indetermining the one or more concentrations.
 19. The system recited inclaim 17, comprising: a network; at least one additional computercoupled to the network; and means for enabling the computer and at leastone additional computer to share the determined concentrations.
 20. Thesystem recited in claim 19, a dosing chart output to provide apharmacist with information as to how to compound a particular drug. 21.The system recited in claim 17, comprising a process executing on thecomputer to determine a low concentration, an intermediate concentrationand a high concentration.
 22. The system recited in claim 17, comprisinga table that is marked to illustrate a range of infusion rates for eachof the determined one or more concentrations.
 23. The system recited inclaim 22, wherein the marking is color.
 24. The system recited in claim22, wherein in the table can be displayed to show infusion rates in oneof units of ml and percentage of maintenance.